1. Field of the Invention
The invention relates to a surgical set of instruments used to treat surfaces of cartilage, bone or body tissue, which set comprises a surgical instrument 1 and a guide device 2 to guide said instrument and/or a tissue applicator 3 for inserting tissue on a defect to be covered. In the meaning of the present invention, the surgical instrument, which can be moved in a circular, elliptical or another way with the aid of the guide device 2 according to the invention, is understood to be a shaver, a scalpel, a drill, a curette, a syringe, or a probe. Depending on the surgical problem, however, other instruments for cutting, milling, punching, sewing, or setting bores in cartilage, bone or body tissue, or injecting operating aids such as glues may also be moved in a specific surface profile using the guide device of the invention.
The surgical set of instruments according to the invention is particularly advantageous for microinvasive work on most various organs, e.g. the intervertebral disk, and especially in arthroscopic work. For example, cartilage defects represent a major problem in reconstructive joint surgery as a result of the lacking regenerative capability of cartilage, giving rise to joint mechanical disorders, increasing cartilage wear in adjacent areas, and post-traumatic arthroses. xe2x80x9cDer Unfallchirurgxe2x80x9d, published by E. Markgraf and K. E. Rehm, Springer Verlag, 60th Annual Meeting of the Deutsche Gesellschaft fur Unfallchirurgie e.V., Nov. 20-23, 1996, Berlin, Abstracts, Forum: Experimentelle Unfallchirurgie, page 283, describes a method of biotechnological cartilage reconstruction using cultivated chondrocytes and a collagen sponge. Using this method, the in vitro production of autologous cartilage tissue in any desired shape and size is possible by isolating cartilage cells from the kneecaps of freshly slaughtered calves and placing them on a collagen sponge. Thereafter, the chondrocyte-collagen fleece artificial structure is cultivated with addition of L-ascorbic acid, L-glutamine, antibiotics, and fetal calf serum.
Subsequently, this artificial structure is implanted subcutaneously in naked mice, and new cartilage is generated in the form of the collagen sponge used. Hyaline cartilage is detected, as well as type II collagen which is specific for this cartilage.
A similar method is described in the U.S. patent specification U.S. Pat. No. 4,846,835. This written specification discloses the application of a patch of periosteum on the cartilage defect following implantation of the chondrocyte-collagen material to effect mechanical fixation thereof. Said U.S. Pat. No. 4,846,835 describes the transplantation procedure on rabbits. There is no description of a device for collecting and applying periosteum tissue that would ensure efficient operation with high quality and at the same time, minimize the risk for a patient. Operations are performed on open knees, the periosteum patch is collected with a scalpel and likewise, the lesion is prepared using a scalpel.
2. Description of the Related Art
Likewise, in xe2x80x9cClinical Orthopaedics and Related Researchxe2x80x9d No. 326, pp. 270-283, 1996, Matts Brittberg et al. describe this transplantation method using autologous chondrocytes on New Zealand rabbits where, inter alia, autologous chondrocytes are cultivated on a carbon fiber fleece, and this chondrocyte/carbon fiber fleece structure is implanted.
However, this reference, as well as numerous other publications by Mats Brittberg et al. solely describe transplantation procedures on open knees. Meanwhile, this open knee transplantation method is also performed in human medicine clinical practice.
However, classical operations on open joints always involve the risk of wound inflammation, the postoperative pain is considerable, the period of rest in hospitals is longer, as is the rehabilitation period.
It is the object of the present invention to develop a surgical set of instruments permitting accurate guidance of the surgical instrument according to the area to be treated, which allows operating both on open defects and in a microinvasive fashion and, in particular, is suitable for arthroscopic operation.
More specifically, it is the object of the invention to develop an efficient transplantation method for the biotechnological cartilage reconstruction on humans, which utilizes the in vitro cultivation of autologous cartilage cells, their transplantation into the cartilage defect, and the closure of said defect using periosteum tissue, but does not require open joint operations.
The object of the invention is accomplished by means of a surgical set of instruments comprising a surgical instrument (1) and a guide device (2) for orthogonal or horizontal treatment of cartilage, bone or body tissue surfaces according to the claims. The guide device comprises one proximal and one distal guide element allowing a reproducible motion of the surgical instrument (1) through an invariant point P, where the size of the area to be treated (preferably a circle or an ellipse) can be varied by varying the distance between the two guiding elements. The size of the tissue area to be treated is determined by the ratio of the distance between the two guide elements and the distance from the invariant point to the area of tissue to be treated, with simultaneous consideration of the angle between the imaginary straight lines a and b, where straight line a passes through the invariant point and centrally through the geometrical figure formed by the guide elements, while straight line b passes through the invariant point and tangentially to the most distant point through the geometrical figure formed by the guide elements.